As we move into the new system of Integrated Care a question is emerging around the role of LMCs, and how it will be impacted by the change.

In a traditional purchaser provider model it makes lots of sense to have someone whose job it is to negotiate contracts on behalf of the provider.  Hospital trusts have contracting teams, and general practice has the GPC nationally and LMCs locally.  LMCs have a statutory duty to represent GPs at a local level, and are mandated to represent and negotiate on behalf of their local GP practices.

Whilst recognised by statute and having statutory functions, LMCs are not themselves statutory bodies.  They are independent, and it is this independence that means most GPs and practices trust their LMC to stand up for and support them.  Current legislation includes a requirement for NHS Bodies to consult with the LMC on issues that relate to general practice in their locality.

However, the new guidance on Integrated Care Systems states,

“It should be recognised that there is no single voice for primary care in the health and care system, and so ICSs should explore different and flexible ways for seeking primary care professional involvement in decision-making.” p27

It then goes on to say,

“PCNs in a place will want to consider how they could work together to drive improvement through peer support, lead on one another’s behalf on place-based service transformation programmes and represent primary care in the place-based partnership. This work is in addition to their core function and will need to be resourced by the place-based partnership.” p28

LMCs are not explicitly mentioned in the guidance.  The implication of the paragraphs above is that it will be PCNs representing primary care (i.e. not LMCs), and it will be up to each local area to decide how LMCs should be involved.

The challenge is that fundamental to integrated care is the need for collaboration and joint working between partners.  This requires give and take on all sides, something LMCs will find difficult because their mandate is only for general practice, and it would be hard for them to justify making concessions around the role of general practice for the greater good to their member practices.  The reality is most LMCs would not, and it is for that reason that those establishing place based arrangements in most areas will be reluctant to include LMC representation.

But if the LMC are not included it potentially serves to make life difficult for those who are representing general practice within the integrated care arrangements.  It is going to be hugely undermining if the representative agrees something for general practice, only for it to be rejected by the LMC (and then most likely member practices) at a later stage.  It won’t just be undermining for the individual leader, it will actually serve to undermine the voice and influence of general practice within the system, as it will reinforce the lack of confidence that some parts of integrated care systems have in general practice.

Any system that is formed as a collaboration of different organisations will necessarily be political.  Integrated Care Systems will be no different.  If general practice is going to be effective within the new systems it will need to find ways of bringing LMCs and PCNs (plus federations and any other general practice leaders) together itself, so that it can operate collectively and effectively.  The system is not going to do it for general practice, and unless general practice can create its own internal coherence it is at risk of having little or no influence on the new system as it develops.